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Published on: March 24, 2023
Clinical utility of single-balloon enteroscopy for malignant small bowel tumors
Jiro Kawashima1, Shin-Ei Kudo1, Noriyuki Ogata2
1Digestive Disease Center, Showa Medical University Northern Yokohama Hospital, 35-1, Tsuzuki, Yokohama, Kanagawa, 224-8503, Japan.
Background:
Accurate pre-treatment characterization of small bowel tumors (SBTs) is essential because therapeutic strategies differ markedly by pathology. Although single-balloon enteroscopy (SBE) enables direct visualization, localization, and biopsy, its clinical utility for treatment planning in malignant SBTs remains insufficiently characterized.
Methods:
This retrospective single-center study included patients who underwent SBE for suspected SBTs between September 2005 and July 2024, excluding hereditary polyposis syndromes. The analysis was restricted to malignant lesions; therefore, diagnostic-performance indices were not estimated. Outcomes were establishment of an SBE-derived pre-treatment diagnosis, concordance among these lesions, lesion reach rate, biopsy yield, tattooing rate, and avoidance of surgery required for diagnosis.
Results:
Among 1407 SBE examinations in 1089 patients, 86 malignant lesions in 85 patients were analyzed. The most common indication was obscure gastrointestinal bleeding (36.0%). Malignant lymphoma was most frequent (40.7%), followed by adenocarcinoma (22.1%), gastrointestinal stromal tumor (18.6%), and metastatic carcinoma (12.8%). The target lesion was reached in 84.9% (73/86). An SBE-derived pre-treatment diagnosis was established in 75.6% (65/86), with 95.4% (62/65) concordance with the final diagnosis. Biopsy yielded pathological confirmation in 92.9% (52/56); the intention-to-diagnose yield was 60.5% (52/86). Tattooing was performed in 65.6% (40/61) of treated lesions overall and 83.3% (40/48) of reached treated lesions. Diagnostic surgery was avoided in 75.6% (65/86) of lesions overall and 82.9% (29/35) of malignant lymphoma lesions.
Conclusions:
In this malignant SBT cohort, SBE provided clinically useful information for lesion localization, histological confirmation, and treatment planning. Diagnostic surgery was avoided in 75.6% of lesions; however, this descriptive workflow finding should not be interpreted as a demonstrated causal effect of SBE.
Insights
Single-balloon enteroscopy (SBE) aids in diagnosing small bowel tumors (SBTs), offering accurate pre-treatment characterization and enabling avoidance of diagnostic surgery in many cases. This study highlights SBE
Area of Science:
- Gastroenterology
- Endoscopy
- Oncology
Background:
- Accurate pre-treatment characterization of small bowel tumors (SBTs) is crucial for appropriate therapeutic strategies.
- Single-balloon enteroscopy (SBE) offers direct visualization, localization, and biopsy capabilities for SBTs.
- The clinical utility of SBE for treatment planning in malignant SBTs requires further characterization.
Purpose of the Study:
- To evaluate the clinical utility of SBE in providing pre-treatment diagnosis and aiding treatment planning for malignant small bowel tumors.
- To assess the diagnostic yield, lesion reach rate, and impact on surgical intervention for SBTs using SBE.
Main Methods:
- Retrospective single-center study of patients undergoing SBE for suspected SBTs (excluding hereditary polyposis syndromes).
- Analysis focused on malignant lesions, assessing SBE-derived pre-treatment diagnosis, concordance with final pathology, lesion reach, biopsy yield, tattooing, and avoidance of diagnostic surgery.
Main Results:
- SBE reached the target lesion in 84.9% of malignant SBT cases.
- A pre-treatment diagnosis was established in 75.6% of cases, with 95.4% concordance to final pathology.
- Diagnostic surgery was avoided in 75.6% of lesions, particularly in malignant lymphoma (82.9%).
Conclusions:
- Single-balloon enteroscopy (SBE) provides valuable pre-treatment diagnostic information for malignant small bowel tumors, aiding in localization and histological confirmation.
- SBE facilitates treatment planning and can help avoid unnecessary diagnostic surgery in patients with malignant SBTs.
- While SBE demonstrates utility in workflow, the avoidance of surgery should be viewed as an observed outcome rather than a directly proven causal effect.
